Skip to main content

Patient and carer questionnaire

Our submission form will only take a few minutes to complete but responses will be lost if you navigate away from the form before clicking the 'Submit' button at the end. 

You can give us as much information as you like but please don’t give any personal details on the form that might identify you or someone else (such as full names, dates of birth, addresses). If you do include any personal details, we'll remove them before we send your submission to committee members.

We will NOT publish your responses on this website or in the public domain. Any information you give us using this form will only be used for the appraisal of the medicine stated. We will not use it for any other purpose or share it with third parties. We collect and store all submissions within the provisions of the UK Data Protection Act 1998 and the General Data Protection Regulations (GDPR) 2018. Please see our Privacy Policy or contact us for more information.

If you have any questions, or if you find it difficult to fill in the form, please contact us and we’ll try to help. You might also find our FAQs useful, see our New medicines needing your views page.